Non-CPAP therapies in obstructive sleep apnoea: mandibular advancement device therapy

Abstract

Mandibular advancement devices (MADs) represent the main non-continuous positive airway pressure (non-CPAP) therapy for patients with obstructive sleep apnoea (OSA). The aim of the European Respiratory Society Task Force was to review the evidence in favour of MAD therapy. Effects of tongue-retaining devices are not included in this report.Custom-made MADs reduce apnoea/hypopnoea index (AHI) and daytime sleepiness compared with placebo devices. CPAP more effectively diminishes AHI, while increasing data suggest fairly similar outcomes in relation to symptoms and cardiovascular health from these treatments. Patients often prefer MADs to CPAP. Milder cases and patients with a proven increase in upper airway size as a result of mandibular advancement are most likely to experience treatment success with MADs. A custom-made device titrated from an initial 50% of maximum mandibular advancement has been recommended. More research is needed to define the patients who will benefit from MAD treatment compared with CPAP, in terms of the effects on sleep-disordered breathing and on other diseases related to OSA.In conclusion, MADs are recommended for patients with mild to moderate OSA (Recommendation Level A) and for those who do not tolerate CPAP. The treatment must be followed up and the device adjusted or exchanged in relation to the outcome.

The Comparison of CPAP and Oral Appliances in Treatment of Patients With OSA: A Systematic Review and Meta-analysis

“…However, CPAP reduced AHI more efficiently and gave a higher success rate in all these studies. [10][11][12][13][14][15][21][22][23] Overall, these PSG outcomes (especially hypoxia) are of crucial importance with regard to survival and morbidity in subjects with OSA, which emphasizes the relevance of optimal suppression of respiratory disturbances and argues against OA's treatment effect on OSA in terms of these respiratory parameters, 31,32 indicating that OAs can be given only for those who refuse CPAP.…”

Mandibular Advancement Device Therapy in Obstructive Sleep Apnea and Snoring in Community Dental Care: Two-year Follow-up Study on Self-reported Sleep Quality, Side Effects, and Compliance

“…In these patients, clinical studies have shown equal efficacy between both modalities on ambulatory blood pressure, daytime sleepiness, and quality of life, among other things [1]. These results may also be explained by good clinical use of MAD, since particularly in mild OSA, the compliance with CPAP is frequently far from optimal [2][3][4][5].…”

Nocturnal Blood Pressure Is Reduced by a Mandibular Advancement Device for Sleep Apnea in Women: Findings From Secondary Analyses of a Randomized Trial

“…We used self‐assessments of adherence, which is a limitation in the present study. Compliance monitors were not widely available when the study was designed 30. A later study, comparing the results of objectively measured adherence with subjectively reported use, found only a 30‐minute longer sleeping time in the subjective reports 31…”